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Abstract
SummaryBackgroundEvidence of the comparative effectiveness of biological therapies for psoriasis on health‐related quality of life (HRQoL) in routine clinical practice is limited.ObjectivesTo examine the comparative effectiveness of adalimumab, etanercept and ustekinumab on HRQoL in patients with psoriasis, and to identify potential predictors for improved HRQoL.MethodsThis was a prospective cohort study in which changes in HRQoL were assessed using the Dermatology Life Quality Index (DLQI) and EuroQoL‐5D (EQ‐5D) at 6 and 12 months. Multivariable regression models were developed to identify factors associated with achieving a DLQI of 0/1 and improvements in the EQ‐5D utility score.ResultsIn total, 2152 patients with psoriasis were included, with 1239 patients on adalimumab, 517 on etanercept and 396 on ustekinumab; 81% were biologic naïve. For the entire cohort, the median (interquartile range) DLQI and EQ‐5D improved from 18 (13–24) and 0·73 (0·69–0·80) at baseline to 2 (0–7) and 0·85 (0·69–1·00) at 6 months, respectively (P < 0·001). Similar improvements were achieved at 12 months. At 12 months, multivariable regression modelling showed that female sex, multiple comorbidities, smoking and a higher DLQI or a lower EQ‐5D utility score at baseline predicted a lower likelihood of achieving a DLQI of 0/1 or improvement in the EQ‐5D. Compared with adalimumab, patients receiving etanercept, but not ustekinumab, were less likely to achieve a DLQI of 0/1. There was no significant difference between the biological therapies in EQ‐5D improvement.ConclusionsIn routine clinical practice biological therapies produce marked improvement in HRQoL, which is influenced by the choice of biological therapy, baseline impairment in HRQoL, lifestyle characteristics and comorbidities. These findings should help inform selection of optimal biological therapy for patients related to improvements in HRQoL.
Highlights
Due to its large size, rigorous data collection process, detailed collection of patient demographic characteristics and treatment regimens, and high external validity through participation of 153 dermatology centres,[34] the register represents an ideal resource to assess the impact of biological therapies on health-related quality of life (HRQoL) in patients with psoriasis in routine clinical practice. In this longitudinal observational study, we examined the comparative effectiveness of adalimumab, etanercept and ustekinumab on improvements in HRQoL in patients with psoriasis, and identified factors associated with these improvements
Sensitivity analyses were performed to investigate improvements in the Dermatology Life Quality Index (DLQI) and EQ-5D among patients who remained. This large prospective cohort study found that in routine clinical practice, the use of biological therapies for psoriasis is Interestingly, we found that the effectiveness of biological therapies in patients in the British Association of Dermatologists Biologic Interventions Register (BADBIR) was less than their reported efficacy in randomized controlled trials (RCTs)
We have shown that patients on etanercept, but not ustekinumab, were less likely to achieve a DLQI of 0/1 compared with those on adalimumab
Summary
To examine the comparative effectiveness of adalimumab, etanercept and ustekinumab on HRQoL in patients with psoriasis, and to identify potential predictors for improved HRQoL
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